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General NPI Number Information
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NPI Number | 1679964456
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Entity Type | Organization
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Legal Business Name | J. CHUNG, D.D.S., INC.
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Dates
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Enumeration Date | 02/14/2015
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Last Update Date | 02/14/2015
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Provider Practice Location Address
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Address Line | 3250 W OLYMPIC BLVD STE 208
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City | LOS ANGELES
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State | CA
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Zip | 90006-2367
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Country | US
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Telephone | 323-766-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 W OLYMPIC BLVD STE 208
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City | LOS ANGELES
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State | CA
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Zip | 90006-2367
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Country | US
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Telephone | 323-766-1004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOO SUNG CHUNG
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Credential | DMD
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Telephone | 323-766-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 45444
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License Number State | CA
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